Objective: We examined whether childhood exposure to psychological trauma is associated with greater suicidality and whether specific psychiatric disorders modulate this association in a representative sample of Korean adults.

Methods: The Korean version of the Composite International Diagnostic Interview 2.1 was administered to 6,027 subjects aged 18-74 years. Subjects who experienced a traumatic event before the age of 18 years, the childhood-trauma-exposure group, were compared with controls without childhood trauma exposure.

Results: Childhood exposure to psychological trauma was associated with lifetime suicidal ideation (OR=3.19, 95% CI=2.42-4.20), suicide plans (OR=4.15, 95% CI=2.68-6.43), and suicide attempts (OR=4.52, 95% CI=2.97-6.88). These associations weakened after further adjustment for any psychiatric disorders, but they were not eliminated. The risk of suicide attempts related to childhood trauma increased with the presence of a concurrent alcohol use, depressive, or eating disorder.

Conclusion: In terms of clinical implications, patients with these disorders who have a history of childhood trauma should be carefully assessed for their suicide risk and aggressively treated for psychiatric disorders.

Figure 1: Modulation (A) and mediation (B) of the relationship between childhood trauma and suicide attempts by psychiatric disorders.

Mentions:
In a retrospective cohort study of 17337 adults in San Diego County who completed a survey about adverse childhood experiences, suicide attempts, and multiple other health-related issues, Shanta et al.2 found that adverse childhood experiences in any category increased the risk of attempted suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted suicide during childhood/adolescence and adulthood. Adjustment for illicit drug use, depressed affect, and self-reported alcoholism reduced the strength of the relationship between the ACE score and suicide attempts. Data from the Childhood Trauma Survey conducted via telephone in Australia (n=2,559), Bedi et al.11 found that among those sexually abused as children, odds of suicide attempts were 3.4 times higher among women and 2.8 times higher among men, compared with those not abused. Odds ratios (OR) were reduced (2.6 for women and 2.3 for men), but remained statistically significant after adjusting for the presence of major depressive disorder. In the National Comorbidity Survey of the US using the Composite International Diagnostic Interview (CIDI) (n=5,877), Molnar et al.4 also found that controlling for lifetime psychiatric illnesses weakened the association between childhood abuse and suicide attempts, but it did not eliminate this association. All of these studies suggest partial mediation of the childhood traumatic experience-suicide attempt relationship by the psychopathology such as depression.2,4,11 However, it is not clear whether the impact of childhood trauma on subsequent suicide attempts is modulated by the occurrence of psychiatric disorders (Figure 1A) as well as mediated by the certain psychopathology (Figure 1B). In other words, it remains unknown whether the degree of the association between childhood trauma and suicide attempts differ or not between groups with and without specific psychiatric disorders.

Figure 1: Modulation (A) and mediation (B) of the relationship between childhood trauma and suicide attempts by psychiatric disorders.

Mentions:
In a retrospective cohort study of 17337 adults in San Diego County who completed a survey about adverse childhood experiences, suicide attempts, and multiple other health-related issues, Shanta et al.2 found that adverse childhood experiences in any category increased the risk of attempted suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted suicide during childhood/adolescence and adulthood. Adjustment for illicit drug use, depressed affect, and self-reported alcoholism reduced the strength of the relationship between the ACE score and suicide attempts. Data from the Childhood Trauma Survey conducted via telephone in Australia (n=2,559), Bedi et al.11 found that among those sexually abused as children, odds of suicide attempts were 3.4 times higher among women and 2.8 times higher among men, compared with those not abused. Odds ratios (OR) were reduced (2.6 for women and 2.3 for men), but remained statistically significant after adjusting for the presence of major depressive disorder. In the National Comorbidity Survey of the US using the Composite International Diagnostic Interview (CIDI) (n=5,877), Molnar et al.4 also found that controlling for lifetime psychiatric illnesses weakened the association between childhood abuse and suicide attempts, but it did not eliminate this association. All of these studies suggest partial mediation of the childhood traumatic experience-suicide attempt relationship by the psychopathology such as depression.2,4,11 However, it is not clear whether the impact of childhood trauma on subsequent suicide attempts is modulated by the occurrence of psychiatric disorders (Figure 1A) as well as mediated by the certain psychopathology (Figure 1B). In other words, it remains unknown whether the degree of the association between childhood trauma and suicide attempts differ or not between groups with and without specific psychiatric disorders.

Bottom Line:
We examined whether childhood exposure to psychological trauma is associated with greater suicidality and whether specific psychiatric disorders modulate this association in a representative sample of Korean adults.Childhood exposure to psychological trauma was associated with lifetime suicidal ideation (OR=3.19, 95% CI=2.42-4.20), suicide plans (OR=4.15, 95% CI=2.68-6.43), and suicide attempts (OR=4.52, 95% CI=2.97-6.88).These associations weakened after further adjustment for any psychiatric disorders, but they were not eliminated.

Objective: We examined whether childhood exposure to psychological trauma is associated with greater suicidality and whether specific psychiatric disorders modulate this association in a representative sample of Korean adults.

Methods: The Korean version of the Composite International Diagnostic Interview 2.1 was administered to 6,027 subjects aged 18-74 years. Subjects who experienced a traumatic event before the age of 18 years, the childhood-trauma-exposure group, were compared with controls without childhood trauma exposure.

Results: Childhood exposure to psychological trauma was associated with lifetime suicidal ideation (OR=3.19, 95% CI=2.42-4.20), suicide plans (OR=4.15, 95% CI=2.68-6.43), and suicide attempts (OR=4.52, 95% CI=2.97-6.88). These associations weakened after further adjustment for any psychiatric disorders, but they were not eliminated. The risk of suicide attempts related to childhood trauma increased with the presence of a concurrent alcohol use, depressive, or eating disorder.

Conclusion: In terms of clinical implications, patients with these disorders who have a history of childhood trauma should be carefully assessed for their suicide risk and aggressively treated for psychiatric disorders.